Accurate Diagnosis of Back Pain Causes
Diagnosis is Key
To properly fix a problem one must first diagnose what is causing it. Often times when medical problems are misdiagnosed they progressively worsen ultimately resulting in permanent damage or death. The sooner an accurate diagnosis is made the better the prognosis as prompt appropriate treatment has a better chance of resolving the condition. This is true whether we are dealing with a back strain or a serious cancer. A physician’s ability to diagnose the problem is instrumental in successful treatment.
In medical school the best instruction I ever received was that 80% of the diagnosis lies in the history. If you ask the right questions and listen well to the patient’s answers many times the diagnosis can be made before any fancy, expensive tests are employed. A skillful exam will also help to pinpoint the diagnosis. And yes at times we will rely on diagnostic imaging or lab tests to confirm or exclude a diagnosis.
Diagnosis is also important for determining causation. When we look at an outcome we need to know what the diagnosis was that led to that outcome. Working backwards we can then determine if it is plausible for an event to cause the diagnosis that leads to the resultant outcome. If there is no more likely explanation to cause the diagnosis than causation can be determined.
For a patient that suffers from low back pain the physician must first determine when it started, what makes it better or worse, where is it located and is it associated with pain down the leg or leg weakness. These complaints are part of the history that helps formulate a differential diagnosis. The exam and subsequent tests will eventually lead to a specific diagnosis that can result in appropriate treatment. However when the outcome is less than desirable the question of cause may be raised. For the patient with a herniated disk and pinched nerve resulting in back and leg pain after a car accident it seems logical that the force of the accident caused the disc to herniate and the back and leg to become symptomatic. However, if the patient had previous back pain and degenerative disc disease, causation may not be so obvious. Regardless an accurate diagnosis is needed to determine cause.